Prior to this inspection we had received information of concerns about various aspects of care and support for people who used the service. We carried out a responsive inspection to find out whether people were receiving safe and appropriate care.An inspector from the Care Quality Commission (CQC) conducted this inspection. We looked at care records for four people. We spoke with six people who used the service and greeted the majority of people, some of whom had returned from the day centres. We spoke with two relatives who had visited the home on the day of the inspection and members of staff including the registered manager.
We used the information we had gathered to answer the five questions we always ask:
Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?
This is a summary of what we found:
Is the service safe?
The people we spoke with said that they were well looked after and cared for. People had their needs assessed and were met appropriately. One person said 'Staff are very good. I get good care and I feel safe here.' A parent said 'My daughter is safe. The staff know her well. I am involved in the care plan reviews. I have no complaints.'
The system for the management and administration of medicines was ineffective because people were not protected against the risks associated with medicines. There were no proper arrangements in place to prevent medicine error from happening.
The CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. There was one DoLS currently in place for restricted visits and eight applications had been submitted under this system.
Is the service effective?
People who used the service received care and support that met their needs. People and their relatives were involved in regular care plan reviews. One parent said, 'I am involved in the care plan reviews. The staff know my daughter very well and they support her in a professional manner. Regular care plan reviews had taken place to ensure that people and their relatives were aware of the changes in their health and wellbeing. Where appropriate the support and advice of other health care professionals had been sought to ensure that people's health care needs were met.
Not all staff members had received relevant training for the work they did. They did not receive regular formal supervision. This meant that their work had not been appraised regularly. Therefore, people were not supported to deliver care and support safely and to an appropriate standard to ensure that people's needs were met.
Is the service caring?
People who used the service told us that they were well looked after and cared for. One person said 'Staff are very good. I feel safe here.' A parent said, 'My daughter took nearly one year to settle down. But now she is happy and her needs are met.' Another parent said 'Staff are caring and they are welcoming. I have no concerns about the care my daughter received.'
Is the service responsive?
The care plans we looked at showed that people's needs had been assessed and met appropriately. People had been involved in the decisions about their care and any changes in their care needs had been discussed with them and their relatives.
One parent said, 'The staff do respond quickly in an emergency. For example when my daughter had an epileptic seizure, staff called the ambulance because they had followed the protocol.'
We noted that the services of other health care professionals had been sought to ensure that people had been cared for and supported appropriately.
We saw that the home had a complaints procedure in place and there was evidence of complaints that had been dealt with in line with the home's policy. One parent told us about a complaint they had made and that they were happy about the outcome. We checked the complaint that had been made which confirmed that it had been dealt with according to what the complainant had told us.
Is the service well-led?
The service had a registered manager in place.
People's care and support had been planned and delivered in accordance with their identified needs. The provider had carried out an annual questionnaire survey for people who used the service, their relatives and other stake holders. However, we found that the system in place for assessing and monitoring the quality of service was ineffective. The audits carried out for the administration and management of medicines had failed to identify issues we had found. The provider did not have a system in place to ensure that all staff had received the required training for the work they did. There had been on-going problems with the phone system which had not been addressed.